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Wear it Right! Army Uniform Guide

DA Form 4187 Personnel Action – Current Form and Also a Historical Copy Version That has Been Pre-filled Out as a Request to Change Name in Official Records Example

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Download Current Blank Fillable PDF Format Click Below


This is a Historical Copy DA Form 4187 pre-filled out as a Request to Change Name in Official Records Example. It can be used as a guide when you need to fill out a form DA 4187 and fill it out as a Request to Change Name in Official Records. Download Historical Copy MS Word Format Click Below


Note: Current form is not available in XFDL IBM Lotus Forms Viewer/Pure Edge Format

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  • Kathy Renbarger


    I’m trying to research the provenance of the DA Form 3284-R, “Applicant’s Statement of Name Change” (AR 601-210), which I filled out in Jan. 1973, as a part of my enlistment paperwork. Unfortunately, that form was only used between 1 Nov. 1967 and Sept. 1976, when it was made obsolete. There is virtually nothing else digitized about it. When I filled it out, my recruiter was EXTREMELY EMPHATIC that doing so would constitute a “legal, binding, and permanent” change of my first name, which could only be undone by going to court. I had zero objections to that; since, I had despised my birth certificate first name (Kay) for many years and had been going by my current first name since early June of 1970, when I started going by Kathy. ABSOLUTELY EVERYTHING in my adult (and late teen) life has been under Kathy. The ONE exception (since 2008) has been the name PRINTED ON my driver’s license, which I still sign Kathy. I had accidentally missed my renewal date by about 2 weeks; and, Okla. had just passed a law requiring a birth certificate if a person was even one day late renewing. Until recently, it was merely an annoyance; but, I’m getting to the age where people I know are starting to “drop like flies.” With diver’s licenses no longer being “just driver’s licenses;” but, instead, the “go to identity document,” I can foresee a very real potential for “getting depersoned” in the event of my death or serious incapacitation. Certain people are quite likely to “have issues” with my will; and, the medical industry will DEFINITELY “have issues” with my medical power of attorney instructions.
    I’m told that the provenance of the form (proving that it WAS a “legal, binding, and permanent name change” can be found in the paper archives of the Library of Congress (and similar places); but, I’d need to be able to get to DC or be able to hire a researcher to get copies. Since, (as a disabled senior on a subsistence level income) I can’t even afford the (approx.) $300 to “just start over from scratch,” those other two avenues are closed to me, as well. IF I can get exact citations regarding the provenance, there’s a chance that I can get copies mailed to me; but, without such citations, they won’t even look. Also, IF I could get (notarized?) statements from former Vietnam Era recruiters, who remember using that form, attesting to the fact that it DID constitute a “legal, binding, and permanent” name change, I MIGHT be able to get the judge here to accept a pauper’s affidavit and a waive the publication (which can be even higher than the filing fee!) If that doesn’t work, there’s a chance I could get my state rep. to try to run through a bill “grandfathering” any of us who had our names changed by using that form.
    THANK YOU in advance for any help you can provide!!!

    Since I’m not sure of the policy regarding contact; and, the risk of “bot harvesting,” even if they don’t have issues with contact, I’ll simply say that Seminole, OK only has one primary prefix. If someone was willing to (for example) do a “statement of fact” regarding this form, they can reach me by looking up the number for the Seminole Animal Shelter (or Ace Hardware) and replacing the last four numbers with 2821… (Note to moderators: If this is prohibited, please delete only this paragraph; since, I urgently need a solution to this problem.)

    • Mark Gerecht


      Kathy, try requesting your military personnel file from this website: https://www.archives.gov/personnel-records-center/vso/official-military-personnel-file-contents
      Others have used it and found what they were looking for in their records.

      Hope this helps

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  • Ushelor Lowery


    This is awesome website that will aid 42A in conducting thier daily duties…

    • Part-Time-Commander



      It sure is a great website. The information here will help the 42A and Soldiers from every MOS imaginable.

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